Vertebral body resection in the treatment of cancer involving the spine.

Results of radical spinal surgery with vertebral body resection in of 51 patients with primary and metastatic cancer of the spine were analyzed. Seven patients had primary spine tumors, 16 had paravertebral tumors that involved the spine by direct extension, and 28 had blood-borne metastases to the spine. Thirty-five patients (68%) had prior therapy directed to the spine: 4 had undergone previous surgery, 9 had surgery and radiation, and 22 had radiation alone. Forty-five patients (90%) had intractable pain, and 25 patients (48%) were nonambulatory. Myelography revealed high-grade or complete block in 39 patients (76%). Following surgery, 38 of 45 (84%) had pain relief, and 40/58 (78%) were ambulatory at discharge. Of the 25 patients who were unable to walk prior to surgery, 15 (60%) improved to fully ambulatory status. The surgical mortality was low (4%), and complications were few (10%). These results are superior to those reported following treatment by radiation and steroid therapy. In selected patients who have actual or potential neural compression resulting from tumor within the vertebral body, such surgery should be considered as initial therapy.